What is the discussion on cleft palate and palate?

From the Guidelines

Children with cleft palate should not undergo routine tympanostomy tube insertion at the time of initial cleft surgery, but rather when clinically indicated, such as in the presence of hearing loss and flat tympanograms. This approach is supported by a systematic review of observational studies, as well as more recent research, which concludes that there is inadequate evidence to support routine tube placement in this population 1.

Key Considerations

• Infants with cleft palate often experience otitis media with effusion (OME), which can lead to hearing loss and speech and language disorders.
• The timing of tympanostomy tube insertion is not well established, but a general consensus is to insert tubes when clinically indicated.
• Children with cleft palate have a high incidence of speech and language disorders, continued middle ear disease, and hearing loss, even after early tube placement 1.

Multidisciplinary Management

• A comprehensive approach to managing cleft palate involves coordination between multiple specialties, including plastic surgeons, speech pathologists, audiologists, dentists, orthodontists, and psychologists.
• Regular hearing evaluations are crucial, as children with cleft palate are at higher risk for middle ear infections and hearing loss due to abnormal Eustachian tube function.
• Speech therapy is essential following surgical repair, as many children develop speech difficulties, including hypernasality and articulation problems 1.

Clinical Decision-Making

• Individual characteristics of the child, caregiver input, and multidisciplinary management can help determine optimal timing for tube placement and other interventions.
• The presence of hearing loss and flat tympanograms can inform the decision to insert tympanostomy tubes, highlighting the need for ongoing monitoring and assessment 1.

From the Research

Cleft Palate and Palate Discussion

• Cleft lip with or without a cleft palate (CLP) and cleft palate alone (CPA) are common birth defects, with a combined birth prevalence of about 1 to 2/1,000 2.
• The management of cleft lip and palate requires an interdisciplinary team providing comprehensive care, including audiology, pediatric otolaryngology, speech pathology, occupational/feeding therapy, and genetics 2, 3, 4.
• A multidisciplinary cleft clinic (MCC) is the best environment to deliver care for children with CLP/CPA, as it features a team of healthcare providers and allows for comprehensive addressing of medical issues in a single setting 2.
• The treatment of cleft lip and palate is best conducted by a multidisciplinary team approach, including oral and maxillofacial surgeons, orthodontists, pathological phoneticians, and psychological counselors 4, 5.
• Comprehensive cleft centers (CCC) are permanent centers that offer a multidisciplinary team approach to the treatment of cleft lip and palate, and are shown to be safe, cost-effective, and provide sustainable solutions for cleft care 6.

Treatment Approaches

• Interdisciplinary treatment approaches for cleft lip and palate may include surgical repair, orthodontic treatment, speech therapy, nursing, and psychology 3, 4, 5.
• The use of pre-adjusted edgewise appliances, extraction of multiple teeth, and distalization of the lower right first molar using a temporary anchorage device may be effective in treating patients with cleft lip and palate 3.
• Alveolar bone graft and implant placement may be used to restore missing teeth and achieve satisfactory results 3.

Guidelines and Recommendations

• The Society of Cleft Lip and Palate and the Chinese Stomatological Association have formally applied and approved guidelines for cleft lip and palate team approach management, which recommend a multidisciplinary team approach and describe the primary and secondary surgical repair for cleft lip, cleft palate, and cleft alveolar, as well as orthodontic treatment, speech therapy, nursing, and psychology 4.
• Clinicians should familiarize themselves with special considerations for patients with cleft lip and palate before attempting to care for these individuals, particularly when performing orthognathic surgery 5.